We report a case of exercise-induced acute renal failure associated with renal hypouricemia in a 35- year-old man who complained of oliguria and back pain after swimming. Laboratory tests revealed that serum blood urea nitrogen and creatinine level were elevated, the serum uric acid concentration was subnormal(2.1 mg/dL). After conservative treatment, renal function was recovered. But, uric acid level decreased to 0.4 mg/dL. In addition, there was no supression of urate clearance to creatinine clearnace ratio(CUA/CCr) following the administration of pyrazinamide, and no increase of CUA/CCr after benzbromarone. Therefore, we think the cause of renal hypouricemia in this patient may be the subtotal defect in the urate transport.
Acute Kidney Injury* ; Back Pain ; Benzbromarone ; Blood Urea Nitrogen ; Creatinine ; Humans ; Oliguria ; Pyrazinamide ; Swimming ; Uric Acid

OBJECTIVE: Benzbromarone is a most potent uricosuric agent which has been marketed in Europe. The purpose of this study was to evaluate the safety and efficacy of benzbromarone as a uric acid lowering agent in gouty patients in Korea. METHOD: Twenty-one patients with gout, who were lower excreter of uric acid and had no other complication of gout, were treated with benzbromarone for 6 months. In these patients we checked complete blood count, liver function test, BUN, creatinine, serum uric acid, 24 hour urine uric acid excretion and uric acid clearance before and after treatment with benzbromarone. RESULTS: Significant improvements(p<0.01) were found in the serum uric acid level, 24h uric acid excretion and uric acid clearance. The mean serum uric acid decreased from 8.2mg/dl to 5.1mg/dl at the end of 6 months; mean urinary uric acid excretion increased from 425.9mg/day to 760.3mg/day; and the uric acid clearance increased from 3.5mL/min to 10.9mL/min. There are no clinical or laboratory side effects, except skin rash in the one patient. CONCLUSION: Benzbromarone was effective to control plasma uric acid concentration at doses ranging from 25 to 50mg/day.
Benzbromarone* ; Blood Cell Count ; Creatinine ; Europe ; Exanthema ; Gout* ; Humans ; Korea ; Liver Function Tests ; Plasma ; Uric Acid

Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated.
Allopurinol ; Benzbromarone ; Colchicine ; Debridement ; Decompression ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Joints ; Kidney Failure, Chronic ; Tendons ; Uric Acid

Benzbromarone is a uricosuric agent for hyperuricemia and gout. Some of its well-known side effects include hypersensitivity, renal calculi, and gastrointestinal problems. Although the drug was withdrawn from U.S. market due to severe hepatotoxicity, it is still available in some countries including Korea. We describe a 19-year-old male who was admitted with general weakness and azotemia after use of benzbromarone. A kidney biopsy revealed acute tubular necrosis without an evidence of urate nephropathy. After discontinuation of benzbromarone, the renal function returned to baseline. This is the first case of acute tubular necrosis associated with benzbromarone use.
Azotemia ; Benzbromarone ; Biopsy ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Kidney ; Kidney Calculi ; Korea ; Male ; Necrosis ; Transplants ; Uric Acid ; Young Adult

OBJECTIVE: To investigate the effect of low dose aspirin on serum and urinary uric acid level in gouty arthritis patients. METHODS: 22 male gouty arthritis patients (12 treated with allopurinol and 10 with benzbromarone) were enrolled in a prospective study. Mean age (+/-SD) was 57.3+/-10.4 years. Patients had been treated with hypouricemic agent for at least 3 months. Low dose of aspirin (100 mg/ day) were administered for 4 weeks. During the study period, hypouricemic agents were remained on the same dosage. Demographic data were collected at baseline. Laboratory tests including serum uric acid, blood urea nitrogen, creatinine, 24 hours urine uric acid, creatinine clearance (Ccr), and 24 hours urine urea nitrogen were measured at baseline and then every 4 weeks for 12 weeks. RESULTS: At baseline, there was no difference in age, serum uric acid, 24 hours urine uric acid, Ccr and 24 hours urine urea nitrogen between allopurinol and benzbromarone groups. After aspirin treatment, levels of serum uric acid (p=0.901 by paired t-test in allopurinol group, p=0.617 in benzbromarone group), 24 hours urine uric acid (p=0.789, p=0.410), Ccr (p=0.480, p=0.219), 24 hours urine urea nitrogen (p=0.284, p=0.250) did not change significantly at 0 and 4 weeks. Acute gouty attack did not occur during the study period. CONCLUSION: Low dose aspirin does not influence serum uric acid level or urinary uric acid excretion in gouty arthritis patients treated with allopurinol or benzbromarone.
Allopurinol ; Arthritis, Gouty* ; Aspirin* ; Benzbromarone ; Blood Urea Nitrogen ; Creatinine ; Gout ; Humans ; Male ; Nitrogen ; Prospective Studies ; Urea ; Uric Acid*

Gout is a common chronic inflammatory arthritis that can lead to significant disability. Gout is one of the few rheumatologic diseases that can be diagnosed with certainty and can be cured with appropriate therapy. Alcohol and dietary consumption are related to hyperuricemia and gout attacks. A moderate intake of purine-rich vegetables or protein is not related to an increased risk of gout. A weight-reducing, calorie-restricted diet with moderate carbohydrate restriction was beneficial for gout patients and reduced the serum uric acid and frequency of gout attacks, although these findings need to be confirmed. Clinicians should consider therapeutic options that do not increase the serum uric acid when treating associated conditions in gout patients. The acute gout attack can be treated appropriately with non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids. Hypouricemic treatment reduces the uric acid concentration by inhibiting its production (allopurinol) or enhancing its excretion (benzbromarone). Allopurinol is the agent used most commonly, but the recommended dose often fails to control the serum uric acid. Benzbromarone effectively reduces the serum uric acid, but possible hepatotoxicity should be monitored. Febuxostat, a new xanthine oxidase inhibitor, was recently approved by the Federal Drug Administration (FDA). PEGylated uricase, a potent parenteral hypouricemic agent, is under investigation for the treatment of gout.
Allopurinol ; Arthritis ; Benzbromarone ; Colchicine ; Diet ; Glucocorticoids ; Gout ; Humans ; Hyperuricemia ; Thiazoles ; Urate Oxidase ; Uric Acid ; Vegetables ; Xanthine Oxidase ; Febuxostat

OBJECTIVE: Hyperuricemia is known as a risk factor that causes and worsens kidney diseases through a variety of mechanisms. Recent animal studies reported that the correction of hyperuricemia improved the renal function, but there have been few human studies. This study examined whether a hypouricemic treatment affects the renal function in Korean patients with gout. METHODS: Two hundred sixty-seven gout patients who were prescribed uric acid lowering agents for more than 1 year were enrolled at the Division of Rheumatology in the National Health Insurance Corporation Ilsan Hospital and Yonsei University Severance Hospital from January 2005 to January 2010. The following were examined: the levels of serum uric acid and serum creatinine, the amount of 24-hour urine uric acid, glomerular filtration rate (GFR), and abdominal ultrasound findings at baseline and follow-up. RESULTS: Mean age of the study subjects was 54.4+/-13.9 years. Two hundred forty-seven patients were male and 20 patients were female. The mean treatment duration was 35.0+/-19.5 months. Among the 267 patients, 219 and 19 patients received monotherapy with allopurinol and benzbromarone respectively, and 29 patients received combination therapy with allopurinol and benzbromarone. After the treatment with uric acid lowering agents, the serum uric acid and creatinine levels decreased significantly (8.05+/-1.96 mg/dL vs 6.16+/-1.46 mg/dL, p<0.001, 1.25+/-0.46 mg/dL vs 1.18+/-0.42 mg/dL, p=0.001, respectively) and the GFR increased significantly (74.4+/-27.0 mL/min/1.73 m3 vs 80.2+/-31.6 mL/min/1.73 m3, p<0.001). CONCLUSION: Treatment with hypouricemic agents reduced the levels of serum uric acid and improved the renal function. These results suggest that a hypouricemic treatment might improve the kidney function in gout patients.
Allopurinol ; Animals ; Benzbromarone ; Creatinine ; Female ; Glomerular Filtration Rate ; Gout ; Humans ; Hyperuricemia ; Kidney ; Kidney Diseases ; Male ; National Health Programs ; Rheumatology ; Risk Factors ; Uric Acid

Osteonecrosis (ON) is a common comorbidity in gout; however, avascular ON of multiple sites is unusual. Multifocal ON is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 31-year-old woman diagnosed with gout, who had multifocal ON. Initially, she was treated with benzbromarone, colchicine, and meloxicam. Two years later, she developed severe tophi and was diagnosed with chronic renal failure. Magnetic resonance imaging (MRI) of both legs revealed bilateral ON of the femoral head. She underwent bilateral hip replacement surgeries. After two years, she had pain and limited movements in the left shoulder, with tophi identified via dual-energy computed tomography. Despite management with non-steroidal anti-inflammatory drugs, colchicine, and prednisolone, she had persistent shoulder pain. MRI of the left shoulder revealed ON. She therefore underwent left shoulder replacement surgery. Following the case report, we review the literature on multifocal ON with gout.
Adult ; Benzbromarone ; Colchicine ; Comorbidity ; Female ; Gout* ; Head ; Hip ; Humans ; Kidney Failure, Chronic ; Leg ; Magnetic Resonance Imaging ; Osteonecrosis* ; Prednisolone ; Shoulder ; Shoulder Pain

OBJECTIVETo investigate the quality of life in patients with gout and their influencing factors, and to observe the effects of the intervention program of stage-based treatment of integrative medicine (IM).

METHODSTotally 120 patients with acute attack of gout within 72 h were randomly assigned to the treatment group and the control group, 60 in each group. Patients in the treatment group were treated with Huzhang Tongfeng Granule (HTG), diclofenac sodium extended-release capsule and Jinhuang Ointment (JO) in the acute stage, and Yinlian Tongfeng Granule (YTG) and Benzbromarone Tablet (BT) in the intermission stage. Patients in the control group were treated with diclofenac sodium extended-release capsule in the acute stage, and BT in the intermission stage. All patients were treated for 12 weeks. The quality of life (QOL) before and after treatment was investigated by questionnaire.

RESULTSBefore treatment there were no statistical difference in the physiological function, psychological function, social function, health self-awareness and total score between the two groups (P > 0.05). After treatment the scores of the four aspects and the total score were significantly improved in the two groups (P < 0.01). And the improvement of the treatment group was better than that of the control group (P < 0.01). There was no statistical difference in the gender, age, marital status, educational level, QOL with or without associated disease between the two groups (P > 0.05). The QOL of patients with joint stiffness or deformity was less than that of those without joint stiffness or deformity (P < 0.01). The total QOL scores of the gout patients were obviously correlated with the course of diseases (r = -0.324, P < 0.01).

CONCLUSIONSThe QOL of patients with gout was correlated with the course of disease and joint stiffness or deformity. Stage-based treatment of IM could significantly improve the QOL of f out patients.

Adult ; Aged ; Aged, 80 and over ; Benzbromarone ; therapeutic use ; Diclofenac ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gout ; prevention & control ; therapy ; Humans ; Integrative Medicine ; Male ; Middle Aged ; Quality of Life ; Surveys and Questionnaires ; Universal Precautions

OBJECTIVETo observe the clinical efficacy and safety of Xiezhuo Chubi Recipe (XCR) on hyperuricemic patients.

METHODS99 patients with hyperuricemia were randomly assigned to the XCR group, the Benzbromarone group, and the blank control group. Patients in the XCR group took XCR, one dosage daily, twice per day. Patients in the Benzbromarone group took Benzbromarone Tablet (50 mg each tablet, once per day). Patients in the blank control group were not treated with any drug, but only with clinical observation. Twenty days consisted of one course of treatment. The laboratory data including uric acid, blood routines, urine routines, the liver function, and the renal function were statistically analyzed before and after treatment.

RESULTSThe blood uric acid decreased in the three groups after treatment (P<0.05). The total effective rate was 85.71% in the XCR group, 92.86% in the Benzbromarone group, and 23.33% in the blank control group. There was no statistical difference between the XCR group and the Benzbromarone group (P>0.0167). There was no significant difference in the safety indices such as blood routines, urine routines, liver functions, and renal functions of the XCR group between before and after treatment (P>0.05).

CONCLUSIONXCR could effectively reduce the uric acid level with higher safety.

Adolescent ; Adult ; Aged ; Benzbromarone ; therapeutic use ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Hyperuricemia ; blood ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Treatment Outcome ; Uric Acid ; blood ; Young Adult